Reimbursement rates

[Bgg1]

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Hi all,
I've been in and out of these forums for a bit but only signed up today, and hopefully I'm posting this question in the right section.
I'm trying to understand how reimbursement works with respect to anesthesia for office based GI cases. I'm in the NYC metro area, and we have an office with a high percentage of Fidelis patients. I know the rates are not great, although I'm not sure of exact amounts. However there are others making claims of being able to get $1000 per colonoscopy, which seems to me more than suspect.
If it means we're doing something wrong and should be able to get higher reimbursement I want to know, but if this is something shady I also want to know what to tell our group as to why they shouldn't be tempted by such claims.
Any help is much appreciated.

 

[Hoya11]

Hi all,
I've been in and out of these forums for a bit but only signed up today, and hopefully I'm posting this question in the right section.
I'm trying to understand how reimbursement works with respect to anesthesia for office based GI cases. I'm in the NYC metro area, and we have an office with a high percentage of Fidelis patients. I know the rates are not great, although I'm not sure of exact amounts. However there are others making claims of being able to get $1000 per colonoscopy, which seems to me more than suspect.
If it means we're doing something wrong and should be able to get higher reimbursement I want to know, but if this is something shady I also want to know what to tell our group as to why they shouldn't be tempted by such claims.
Any help is much appreciated.

Our group has good rates like 70th percentile or so with various payers and we will collect 600-800 per colo from private insurance on average

 

[Southpaw]

Colonoscopy is I believe 5 start units and typically 2 time units (15 minute increments). 7 units total. If your contract is $100/unit that’s $700 per colonoscopy. If your contract is low $20s per unit or less (CMS) then you’re getting much less.

 

[Bgg1]

I assume these numbers are more for private insurance. Fidelis (at least here) is mostly Medicaid and New York Essential Care (low income). Maybe I'm wrong but I thought those rates tend to be much lower

 

[Hoya11]

I assume these numbers are more for private insurance. Fidelis (at least here) is mostly Medicaid and New York Essential Care (low income). Maybe I'm wrong but I thought those rates tend to be much lower

Yeah your going to get like 50-200 dollars from that I would estimate

 

[Southpaw]

I assume these numbers are more for private insurance. Fidelis (at least here) is mostly Medicaid and New York Essential Care (low income). Maybe I'm wrong but I thought those rates tend to be much lower

Yes, they would be. Much, much lower (not surprised if in the teens per unit) than commercial (private) insurance.

 

[Bgg1]

That's what I thought. So more likely than not these other guys are either in need of their own bowel prep or might be prison bound. Either way I should probably steer clear.